DÄ internationalArchive7/2009Emergencies Associated With Pregnancy and Delivery – Peripartum Hemorrhage: Cardiovascular Side Effects

Correspondence

Emergencies Associated With Pregnancy and Delivery – Peripartum Hemorrhage: Cardiovascular Side Effects

Dtsch Arztebl Int 2009; 106(7): 113. DOI: 10.3238/arztebl.2009.0113b

Goeters, C

LNSLNS The authors' recommendation of administering uterotonic drugs (box 1) should carry a warning that all commonly used substances have cardiovascular side effects that may have fatal consequences if they coincide with hypovolemia. This is important because nowadays pregnant women are usually of an older age. Close cooperation between obstetricians and anesthetists is key. At Münster University Hospital, for example, an agreement was reached for how to proceed in a scenario of severe postpartum hemorrhage; the choice and maximum dosage of uterotonic medication according to the latest scientific insights and maternal monitoring are closely regulated. Eearly embolization is recommended in hemorrhages that are refractory to treatment (1).

In contrast to continual administration, bolus administration of oxytocin triggers tachycardia and hypotension (2). Angina pectoris and ST segment depression have been found after bolus administration of 10 IU oxytocin during cesarean births (3). Tachycardia and hypotension aggravate the hemodynamic changes in atonic hemorrhages and volume loss. The CEMACH report 1997–9 included details of two maternal deaths in connection with bolus administration of oxytocin in simultaneous hemodynamic instability. The literature provides many examples that continual administration of oxytocin is equivalent to bolus administration. Bolus administration should thus not be undertaken.
DOI: 10.3238/arztebl.2009.0113b

PD Dr. med. Christiane Goeters
Prof. Dr. med. Dr. h.c. H. van Aken
Klinik und Poliklinik für Anästhesiologie und
operative Intensivmedizin des UK Münster
Albert-Schweitzer-Str. 33
48143 Münster, Germany
goeters@anit.-uni-muenster.de
1.
Mathe ML, Morau E, Vernhet-Kovacsik H et al.: Impact of the new French clinical practice recommendations in embolization in postpartum and post-abortion hemorrhage: study of 48 cases. J Perinat Med 2007; 35: 532–7. MEDLINE
2.
Thomas JS, Koh SH, Cooper GM: Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section. Br J Anaesth 2007; 98: 116–9. MEDLINE
3.
Svanstrom MC, Biber B, Hanes M et al.: Signs of myocardial ischaemia after injection of oxytocin: a randomized double-blind comparison of oxytocin and methylergometrine during Caesarean section. Br J Anaesth 2008; 100: 683–9. MEDLINE
4.
Kainer F, Hasbargen U: Notfälle in der Geburtshilfe – peripartale Blutungen. Dtsch Arztebl 2008; 105(37): 629–38.
1. Mathe ML, Morau E, Vernhet-Kovacsik H et al.: Impact of the new French clinical practice recommendations in embolization in postpartum and post-abortion hemorrhage: study of 48 cases. J Perinat Med 2007; 35: 532–7. MEDLINE
2. Thomas JS, Koh SH, Cooper GM: Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section. Br J Anaesth 2007; 98: 116–9. MEDLINE
3. Svanstrom MC, Biber B, Hanes M et al.: Signs of myocardial ischaemia after injection of oxytocin: a randomized double-blind comparison of oxytocin and methylergometrine during Caesarean section. Br J Anaesth 2008; 100: 683–9. MEDLINE
4. Kainer F, Hasbargen U: Notfälle in der Geburtshilfe – peripartale Blutungen. Dtsch Arztebl 2008; 105(37): 629–38.